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Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review)

Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

From the Department of Neurology (D.M.S.), Mount Sinai Medical Center, New York, NY; Department of Rehabilitation Medicine (J.-M.G.), CHU Henri Mondor, Créteil, France; Department of Orthopaedic Surgery (H.K.G.), Royal Children’s Hospital, Victoria, Australia; Toronto Western Hospital (J.M.M.), Ontario, Canada; Department of Neurology (M.N.), Klinikum Augsburg, Germany; Shriners Hospital for Children (B.R.), Portland, OR; Jefferson Medical College (L.L.S.), Philadelphia, PA; and Stanford University (Y.S.), CA.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116 guidelines{at}aan.com

Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of adult and childhood spasticity.

Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and spasticity. Authors reviewed, abstracted, and classified articles based on American Academy of Neurology criteria (Class I–IV).

Results: The highest quality literature available for the respective indications was as follows: adult spasticity (14 Class I studies); spastic equinus and adductor spasticity in pediatric cerebral palsy (six Class I studies).

Recommendations: Botulinum neurotoxin should be offered as a treatment option for the treatment of spasticity in adults and children (Level A).

Abbreviations: BoNT = botulinum neurotoxin; CP = cerebral palsy; FDA = Food and Drug Administration; SNAP = synaptosomal-associated protein; VAMP = vesicle-associated membrane protein.

Supplemental data at www.neurology.org

See pages 1699 and 1707.

Approved by the Therapeutics and Technology Assessment Subcommittee on March 31, 2007; by the Practice Committee on July 12, 2007; and by the AAN Board of Directors on January 30, 2008.

The Mission Statement, Conflict of Interest Statement, Subcommittee and Panel members, AAN classification of evidence, and Classification of recommendations are available as supplemental data on the Neurology® Web site at www.neurology.org.

Endorsed by the American Academy of Physical Medicine and Rehabilitation on March 14, 2008.

Disclosure: Author disclosures are provided at the end of the article.

Received December 6, 2007. Accepted in final form January 30, 2008.

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